门诊高血压病患者合并心血管病危险因素及血压控制现况

Clustering of cardiovascular risk factors and hypertension control status among hypertensive patients in the outpatient setting

目的了解我国门诊高血压病患者合并心血管病危险因素的现况以及血压控制情况。方法2009年6月至12月在全国22个省、自治区和直辖市46家医院依照统一标准，每家医院连续入选门诊高血压病患者至少100例，共入选高血压病患者5206例。资料收集包括问卷调查、体格检查和血生化检测。危险因素的定义依据2010年中国高血压病防治指南。结果（1）61．5％（3203／5206）的患者合并血脂异常，56．0％（2917／5206）的患者合并肥胖，27．8％（1449／5206）的患者合并糖调节受损，34．9％（910／2605）的男性患者目前正在吸烟。（2）88．9％（4630／5206）的患者合并至少1个心血管病危险因素（肥胖、血脂异常、糖调节受损和吸烟），17．4％（906／5206）的患者合并3个以上心血管病危险因素。（3）4．1％（211／5206）的患者心血管病风险水平处于低危，72．5％（3774／5206）的患者处于高危或很高危。（4）门诊高血压病患者的血压控制率为44．3％（2304／5206）。65岁以上患者血压控制率高于35～44岁患者[51．3％（818／1596）比29．6％（160／541），P〈0．01]；心血管病风险水平处于低危的患者血压控制率高于高危或很高危患者[65．4％（138／211）比41．9％（1581／3774），P〈0．01]；1年中规律服药时间在9个月以上的患者血压控制率高于规律服药时间少于6个月的患者[50．7％（1744／3442）比30．0％（391／1305），P〈0．01]。结论我国门诊高血压病患者合并心血管病危险因素的比例高，其中最常见的是血脂异常和肥胖。门诊高血压病患者心血管病风险水平多处于高危或很高危。高血压病患者血压控制率较低。

Objective To investigate the status of the clustering of cardiovascular risk factors and hypertension control among hypertensive patients in the outpatient setting in China. Methods This multi- center cross-sectional study was carried out from June to December 2009. Study patients were consecutively recruited from 46 hypertension outpatient clinics in 22 provinces, autonomous regions, and municipalities of China according to identical inclusion criteria. More than 100 consecutive patients should be recruited in each outpatient clinic, and 5206 hypertensive outpatients were included. The patients were examined by questionnaires, physical examinations, and biochemical analyses. Risk factors were defined according to the 2010 Chinese guidelines for the management of hypertension. Results In this patient cohort, dysfipidemia was found in 61.5% （3203/5206）, obesity in 56.0% （2917/5206）, and impaired glucose regulation in 27.8% （1449/5206） patients. The prevalence of smoking was 34. 9% （910/2605） in male hypertensive patients, 88.9% （4630/5206） hypertensive patients had at least one of the above-mentioned four risk factors and 17.4% （906/5206） had three or more risk factors. Only 4. 1% （211/5206） hypertensive outpatients were classified as low cardiovascular risk patients, 72.5% （3774/5206） hypertensive outpatients were classified as high or very high cardiovascular risk patients. The general blood pressure control rate was 44. 3% （2304/5206） , which was higher in the age group of ≥65 years than in those of 35 -44 years [ 51.3 % （ 818/1596 ） vs. 29.6% （ 160/541 ）, P 〈 0. 01 ], higher in low-risk patients than in high-risk patients [ 65.4% （ 138/211 ） vs. 41.9% （ 1581/3774）, P 〈 0. 01 1 and higher in patients under regular therapy （≥ 9 months per year） than in those of irregular therapy （ 〈 6 months per year）[50.7% （1744/3442） vs. 30. 0% （391/1305） ,P 〈 0. 01 ]. Conclusion Clustering of cardiovascular risk factors, especially dyslipidemia and obesity, is common, and cardiovascular risk is high while blood pressure control rate is low among hypertensive outpatients in China.